Provider Demographics
NPI:1255478434
Name:THRIFTY PHARMACY, INC.
Entity Type:Organization
Organization Name:THRIFTY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-667-2049
Mailing Address - Street 1:127 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:42450-1268
Mailing Address - Country:US
Mailing Address - Phone:270-667-2049
Mailing Address - Fax:270-667-7230
Practice Address - Street 1:127 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:KY
Practice Address - Zip Code:42450-1268
Practice Address - Country:US
Practice Address - Phone:270-667-2049
Practice Address - Fax:270-667-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06919332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
P06919OtherPHARMACY
KY7100172510Medicaid
P06919OtherPHARMACY